Unavailability of asthma drugs in Malawi -report

Sam Banda Jnr, Malawi 
(First published in The Daily Times, Malawi on 2nd May 2013): A survey conducted in some of the country's private pharmacy hospitals, national procurement centre and public hospital pharmacies has revealed an unavailability of some of the asthma drugs and this is highlighted in the global asthma report 2011. The report which is the first of its kind says the survey conducted on availability of surveyed inhalers by country, type of health facility and national essential medicines list in the world, shows that Malawi has a lot to do, as some drugs were not available in the private pharmacy, national procurement centre and public hospital pharmacy.

Some of the surveyed drugs include beclometasone which was available in some instances alongside salbutamol in private and public hospitals alongside procurement centre however; budesonide was not available in all the three.

Ministry of Health spokesperson Henry Chimbali admitted that at times they have experienced stock-outs adding that estimates for NCD's are not that consistent. "The monitoring for NCD's has not been that consistent for the past years but the current system is now looking into all that. We have a specific programme on NCD where we are collecting data among others to form decisions. We have released the extent of NCD's and so more money will be allocated," said Chimbali.

The International Study of Asthma and Allergies in Childhood (ISAAC) in collaboration with the International Union Against Tuberculosis and Lung Health, has released the report that aims at dedicating to help countries including Malawi identify and address the problem of this disease.

Designed for stakeholders from government ministers and policy-makers to health workers and people with asthma, the report which is on www.globalasthmareport.org, provides an overview of what is known about the causes and triggers of the disease, the global incidence, the progress being made and the significant challenges today and for the future.

According to Executive Director of International Union Against Tuberculosis and Lung Health, Nils Billo, the report demonstrates that the suffering and waste of resources caused by not managing asthma effectively are much greater than the cost of effective action. "Asthma is a public health problem that can – and should- be solved now," says Billo in the report.

Asthma is a disease of the bronchial tubes (the airwaves) that typically presents with wheezing, a high pitched whistling sound heard during breathing especially when breathing out. The disease is the most common chronic among children and also affects millions of adults. Some 235 million people worldwide suffer from this non communicable disease. The report however, has not highlighted the number of cases in Malawi.

The World celebrates Asthma Day this year under the theme 'You Can Control Your Asthma.' The World Asthma Day started in 1998 and is organized for by the Global Initiative for Asthma (GINA). GINA is actively working to reduce hospitalizations around asthma worldwide.

World Asthma Day takes place on the first Tuesday of May.

In a related development the International Union Against Tuberculosis and Lung Disease (The Union) says "It's time to control asthma", according to this year's World Asthma Day theme. But The Union says in a press statement says Asthma requires affordable, accessible quality assured essential medicines in order to fight the disease observing that the low availability and the prohibitive cost of asthma inhalers continue to be serious challenges in low- and middle-income countries.

"With the vast majority of the 235 million people affected by asthma living in such limited-resource settings, The Union established the Asthma Drug Facility (ADF) to help overcome these barriers," says the statement.

It further says that through the ADF, low- and middle-income countries can purchase the quality-assured asthma medicines they need at an affordable cost adding that in countries such as Benin, Burundi, Kenya, Sudan and El Salvador, the cost of inhalers has fallen by as much as 50 percent, through ADF.

As a result, a patient with severe asthma can be treated with Beclometasone and Salbutamol for one year for less than 40 Euros. The statement says to ensure the quality of the medicines it provides, the ADF uses a quality assurance system based on World Health Organization (WHO) norms and standards and that prices are kept down by having a limited competitive process among selected manufacturers based on yearly estimated volumes.

"Anyone who has witnessed patients with asthma struggling for breath immediately understands the impact this disease has on individuals, families and communities", says Billo. He says asthma remains grossly under-recognised and under-funded.

"ADF is a good example of an intervention that both save lives and resources. These are the kinds of approaches that will be needed to address not only asthma, but also other non-communicable diseases, as health systems increasingly assume with the dual burden of infectious and chronic diseases," says Billo.

The Union also says it provides ADF clients with training in diagnosis and standard case management of asthma and that this includes a simple system for monitoring patient outcomes, which allows them to evaluate the care offered at their facilities and improve asthma case management – both essential for the long-term control of this chronic disease.

"Our goal for the ADF is to scale it up to reach the millions of people with asthma in low- and middle-income countries who currently have no treatment or inappropriate treatment", says Christophe Perrin, ADF coordinator for The Union. He however says since the ADF does not provide medicines for free, countries need to obtain funds for their initial purchase and set up a sustainable financing strategy.

"For example, Benin's National Tuberculosis Programme and Sudan's Epi-Lab have established revolving funds and cost recovery systems for their asthma programmes. By purchasing ADF's low-priced asthma medicines and applying a 12-18 percent margin, these countries are able to make progress towards controlling asthma by providing their patients with both affordable prices and a sustainable supply of medicines," says The Union.

Sam Banda Jnr, Malawi 
Citizen News Service - CNS
(First published in The Daily Times, Malawi on 2nd May 2013)